Stuck Inside These Four Walls: Robin Kahn has an up close look at the mental health system in Santa Clara County and beyond, finding most programs and services lacking. "We just vegetate in there," she says.

Beyond Warehousing

Will an infusion of new resources transform an ailing mental health system or give us more of the same?

By Raj Jayadev

ROBIN KAHN stares through a glass of water on the round banquet table, as if day-dreaming herself out of the room. She is a uniquely still presence in a room bustling with discussion and movement. She slouches in her chair, her brown hair resting on her shoulders.

Robin has traveled here from her group home to attend a meeting on mental health in Santa Clara County. She'd like to be attentive, but her meds are starting to weigh on her. "Sorry, it's the drugs," she says. "They kinda keep me out of it."
Robin is a sharp contrast to the bundle of energy sitting across from herLyn Boyd. Lyn is more like a soccer mom, the kind that brings the oranges to games, engaged, ready to help the team. She rifles through papers, scoffing at the dismal statistics about mental health needs, partly for the benefit of those around her but more out of raw excitement to be discussing such a personal matter.

"My therapist told me I should come here and tell my story," she announces to the group of 12.

Robin and Lyn are both survivors in their own right. They are "clay that has been through the kiln" as Lyn likes to say, stronger from having lived through the isolation and stigma attached to mental illness.

Out of the roughly 250 attendees, mainly social-service workers, Kahn and Boyd are perhaps the most intimately connected to the future of mental health care reform.

Lyn Boyd worked a job in a marketing agency until she had a breakdown that forced her into the mental health system. She displayed early symptoms that went undiagnosed until she had a complete collapse. "The thing that scared me the most was the thought that I may never get back up again," she says. She has found a therapist that has helped her and is currently on a waiting list to get into a shelter-plus-care program.

Robin Khan was a teenager when she first entered the mental health system, diagnosed with anxiety disorder and put on Xanax and Valium. At 24 she was rediagnosed with being schizoaffective, a cross between being manic-depressive and schizophrenic. Robin has received the full range of Santa Clara's mental health system over the course of years of treatment, including 39 electroshock treatments.

She says public health providers try to remove the stigma of mental illness, but their policies speak to different intentions. She has lived in facilities made for the mentally ill all over Santa Clara Valley and beyondfrom Palo Alto to Santa Cruz and, currently, in San Jose. She says those with mental illness are warehoused out of the public's view. "We just vegetate in there. Most times there's no structure, no groups. That's why all you see driving by a home like that is people milling around smoking."

Robin says the system needs to be reformed if she is to escape it. "There are times I was made to feel subhuman, like a dog in the pound." When asked what treatment methods helped her the most, she says, "In Santa Cruz, they would let us go out to the beach. I would go out there with my journal and tortilla chips and just write. I have boxes filled with journal." The first time she smiled all morning was when she told that story.

New Money

Robin is now a teacher's aide for the man sitting next to her, Dr. Andrew Phelps, a professor teaching at San Jose City College and an organizer for the Accountability Caucus. The group is composed of activists trying to hold mental health providers accountable. They have created a national Internet listserve and blogs for clients to discuss issues with one another and strategize on how to better educate mental health providers.

Dr. Phelps couches the struggle people face with mental health needs not in the language of social services, but in terms of a social movement, and he says that the organizing model is based on groups such as the NAACP. He says, "The stigma people face in the mental health system is like racism; it is endemic."

The group uses the term "mentalism" to describe the prejudice those with mental health challenges face. In fact his identification sticker at the meeting reads "The Justice and Accountability Coalition," a group of civil rights organizations formed after the killing of Cau Bach Tran, a Vietnamese woman shot in her home by San Jose police over a year ago. Police defended their actions by saying Tran was mentally ill.

When asked what changes need to be made in the mental health system, Dr. Phelps says that the answer, like the problem, is a societal issue and not a service one. "We need to look to how we can build a multicultural society, one that respects all people for who they are."

At San Jose City College, Phelps teaches a computer information systems course to mentally disabled students, with an emphasis on overcoming discrimination. Besides teaching about the computer technology, the class pedagogy is based on peer-to-peer support. It is this concept of student helping student that Phelps sees lacking in mental heath providers, even those emboldened by a new allocation of resources provided to the county through the recently passed Proposition 63. The proposition, also called the Mental Health Services Act, will bring Santa Clara County between $17 and $30 million over the course of the next few years.

The initiative is surprisingly Robin Hood­like in a time of shrinking state support systems for the poor. The money comes from a 1 percent tax on personal income from Californians making more than $1 million a year. It will be spent to move from a mental health system that waited for patients to hit rock bottom to a more proactive system, where pre-emptive treatment is a cornerstone.

Phelps is interested in the Mental Health Services Act the way other grassroots leaders are interested in reform instigated from abovewith skeptical curiosity. "Proposition 63 is approaching the mental health crisis as an organizational problem than can be mechanically fixed, but we need more than that," he says. Despite the optimism being shared in this stakeholders meeting at the Wyndham Hotel, he says, Proposition 63 will not amount to the radical shift of thought required of the mental health system. "Though innovation is written into the new law, the system is not attentive enough to what would seriously amount to real change."

At the other tables at the Wyndham, it is easy to be hopeful about the future of the county and state's mental health system, mainly because the architects of the current system seem so critical of the structure they built. The opening PowerPoint presentation feels like a self-effacing indictment of mental health services. According to county data shared at the meeting, 145,000 people in Santa Clara County are in need of public mental health services. The Santa Clara County Mental Health Department, though one of the leading providers of mental health services in the state, serves only 18,000 people a year. Indeed, at the Wyndham, Nancy Pena, director of the county's Mental Health Department, says, "We receive over 100 calls a day for treatment, and we have to turn away over half of them."

The question of whom to serve and whom to turn away is at the heart of the failures of the current mental health system. In an attempt to survive a series of drastic budget cuts directed by the past two gubernatorial administrations, counties have reduced their defined target population to two groups: children with serious emotional disturbances and adults with severe mental illness.

The fallout has been thousands of people ending up on the streets, in jail or emergency care as a result of untreated mental health needs. The effect has brought directors and managers from all parts of the county here to the Wyndham. People sit with their respective departments, sipping coffee around banquet-style tables. Everything seems to be flowing as planned until the question and answer period. Amid conversations of resource distribution and bureaucratic process, a young man sitting alone in the back stood up and told the crowd, "I want to applaud those who have survived the mental health system like myself. Those who are surviving mental illness, please stand up." Out of the couple hundred of participants, only about a dozen stood.

The congregation of mental health experts is only an initial step toward the actual decision-making about how Proposition 63 money should be used. The county says it hopes to keep the process as open as possible, but seeing who answered the call to the Wyndham meeting is a bit deflating. Aren't the most invested people in the mental health system really the patients?

Lyn Boyd, the former marketing executive, says mental health patients in Santa Clara County have traditionally felt locked out of the decision-making, something that might change over time. "The hardest part about having a mental illness is that you have the intelligence, so you can watch how the system is failing you, but you feel unable to do anything about it. You feel like you can't help fix the problem, because at that moment, you yourself need help."